Survival narratives : a means of protecting the self from the threats of psychosis

A grounded theory methodology is used to investigate people with psychotic experiences' constructions of their mental health problems. In-depth interviews were conducted on a sample of 9 people who had been given a diagnosis of schizophrenia. The focus of these interviews was on participants' understanding of the difficulties which had brought them into contact with psychiatric services, and their beliefs about mental illness and schizophrenia in general. The methodological approach taken in this research contrasts with the traditional research in this area (on insight) which assumed that deviations from the expert view of a psychosis were either deficiencies or distortions of knowledge and were in fact a symptom of an underlying pathology. Furthermore, this research challenges the notion that the discourse of people experiencing psychosis is meaningless and unintelligible, and that it should be ignored, discouraged or modified. This research suggests that people with psychosis may develop narratives to account for their subjective experiences of psychotic phenomena in the context of meanings which are available in their culture and in the context of relationships with important others both past and present. The survival narratives evident in this research embodied the struggle that people with psychosis have in maintaining a positive identity, when the core areas of that identity are challenged both by their actual mental health problems as well as the stereotypes and prejudices of mental illness and schizophrenia found in society and in the psychiatric system. Professionals working with people with psychosis must be alert to the negative impact that these social constructions potentially have on people's self-concept and identities, and begin to address this secondary disability both in their individual work and on a systemic level.